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Evaluation of an item bank for a computerized adaptive test of activity in children with cerebral palsy
Stephen M Haley1, Maria A Fragala-Pinkham, Helene M Dumas
1Health and Disability Research Institute, School of Public Health, Boston University, Medical Campus, 580 Harrison Ave, 2nd Floor, Boston, MA 02218, USA. smhaley@bu.edu
Insights
A new item bank and simulated computerized adaptive test (CAT) show promise for assessing activity in children with cerebral palsy (CP). This tool efficiently measures abilities across various ages and motor severities.
Area of Science:
- Pediatric Rehabilitation
- Clinical Assessment
- Measurement Science
Background:
- Contemporary clinical assessments of activity are needed for children with cerebral palsy (CP) across the entire age span.
- Computerized adaptive testing (CAT) offers a potential solution for efficiently assessing children with CP over wide age ranges and functional levels.
Purpose of the Study:
- To examine the psychometric properties of a novel item bank designed for assessing activity level abilities in children with CP.
- To evaluate a simulated computerized adaptive test (CAT) based on this new item bank.
Main Methods:
- A cross-sectional item calibration study was conducted with 308 children and youth with CP (ages 2-20).
- Parent-report data on 45 activity items were collected and analyzed using Item Response Theory (IRT).
- Computer simulations of CAT algorithms were developed to assess scale coverage, score agreement, and validity.
Main Results:
- Confirmatory factor analysis supported the unidimensionality, local item dependence, and invariance of the item bank.
- Simulated CAT scores demonstrated high consistency with full item bank scores (r=.93-.98).
- Activity summary scores effectively discriminated across varying levels of motor severity and correlated well with established measures (e.g., PODCI, Wee-FIM, PedsQL-CP).
Conclusions:
- The developed activity item bank shows promise for a CAT application to assess activity abilities in children with CP.
- The CAT approach is suitable for children with CP across a broad age range and diverse motor severity levels.
- Limitations include a relatively small sample size for IRT development and oversampling of higher-functioning children.
Background:
Contemporary clinical assessments of activity are needed across the age span for children with cerebral palsy (CP). Computerized adaptive testing (CAT) has the potential to efficiently administer items for children across wide age spans and functional levels.
Objective:
The objective of this study was to examine the psychometric properties of a new item bank and simulated computerized adaptive test to assess activity level abilities in children with CP.
Design:
This was a cross-sectional item calibration study.
Methods:
The convenience sample consisted of 308 children and youth with CP, aged 2 to 20 years (X=10.7, SD=4.0), recruited from 4 pediatric hospitals. We collected parent-report data on an initial set of 45 activity items. Using an Item Response Theory (IRT) approach, we compared estimated scores from the activity item bank with concurrent instruments, examined discriminate validity, and developed computer simulations of a CAT algorithm with multiple stop rules to evaluate scale coverage, score agreement with CAT algorithms, and discriminant and concurrent validity.
Results:
Confirmatory factor analysis supported scale unidimensionality, local item dependence, and invariance. Scores from the computer simulations of the prototype CATs with varying stop rules were consistent with scores from the full item bank (r=.93-.98). The activity summary scores discriminated across levels of upper-extremity and gross motor severity and were correlated with the Pediatric
Outcomes:
Data Collection Instrument (PODCI) physical function and sports subscale (r=.86), the Functional Independence Measure for Children (Wee-FIM) (r=.79), and the Pediatric Quality of Life Inventory-Cerebral Palsy version (r=.74).
Limitations:
The sample size was small for such IRT item banks and CAT development studies. Another limitation was oversampling of children with CP at higher functioning levels.
Conclusions:
The new activity item bank appears to have promise for use in a CAT application for the assessment of activity abilities in children with CP across a wide age range and different levels of motor severity.
